Use of a de-epithelialized perimeatal skin flap instead of dorsal subcutaneous flap in snodgrass repair in distal hypospadias

To prevent fistulae, an island of dorsa subcutaneous tissue was used to cover the urethroplasty. The dissection of this flap may compromise blood supply to dorsal skin and its rotation may predispose to penile torsion. This led to the modification of the technique using different types of de-epithelialized skin flap. In this work, the perimeatal skin flap was used in sixteen cases of distal hypospadias; three of them were recurrent with excellent functional and cosmetic results. Optional blood supply to the ultimate skin cover was preserved and penile torsion was avoided

Fasciocutaneous flaps versus muscle flaps for treatment and coverage of chronic osteomyelitis of the tibia

In this study, sixteen cases with tibial bone chronic osteomyelitis were operated upon by debridement and coverage using local muscle flap in eight cases while using fasciocutaneous flap in the other eight ones. The cases were followed up for one year. In each group, three cases were suffering from cortical osteomyelitis only. In the muscle flap group, seven cases [three cortical] healed primarily; while in one case, a persistent sinus was the end result. In the fasciocutaneous group, six cases [three cortical] healed primarily; while in the remaining two ones, the flap failed to eradicate the infection. This study proved the reported efficacy of muscle flap in treating chronic osteomyelitis cases and its superiority over fasciocutaneous flaps. It also pointed to the value of using fasciocutaneous flaps in cortical osteomyelitis with the same results [100%]

Medical head of the gastrocnemius muscle with adipofascial extension flap for tibial bone coverage

The gastrocnemius muscle remains the workhorse for providing soft tissue over the knee and upper tibia. Other local flaps were described to be used as an alternative to the gastrocnemius muscle as for example the posterior fasciocutaneous flap and saphenous flap. In this study, ten cases of defects located along the upper two thirds of the tibia which were covered using the medial head of gastrocnemius muscle with adipofascial extension flap were described. Nine flaps survived completely and one flap had marginal loss of 1cm. it was noticed that an adipofascial extension up to 12 x 6 cm can be elevated simply, survives in most of the cases and enable the surgeon to cover the whole length of the upper two thirds of the tibia. Also, it can be used in cases of scarred leg skin, it preserves normal leg skin, it is easy to perform subsequent orthopaedic work underneath and effective in the treatment of osteomyelitis